A review of pancreatic islet autotransplantation.

The current literature suggests that following either total or subtotal pancreatectomy for chronic pancreatitis, the intraportal infusion of the purified or unpurified pancreatic digest will render approximately 50% of patients insulin independent. Early reports suggested that such a procedure might result in hepatic infarction and coagulopathies, but there have been no such complications in the last decade, suggesting that autotransplantation is now associated with low morbidity and mortality. There is an acknowledged subsequent rate of graft failure, but successful long-term insulin independence has now been documented for more than 10 years (Table 1). All centers undertaking total pancreatectomy for benign conditions should examine the possibility of islet autotransplantation, since even a background level of glucose responsiveness is likely to facilitate postoperative management considerably in this difficult group of patients. The process of pancreas dispersion and islet purification should probably be performed in specialist centers with a good understanding of the problems outlined above. While the transport of the pancreas and islets to and from such centers is possible in theory, we suggest that referral of the patient to a specialist center experienced in the surgical technique, transplantation and postoperative management of these patients might be more appropriate.